2011 LIS Road Trip Sign-Up

1.
Thank You!

Thank you for participating in YALSA's 2011 LIS Road Trip! This brief survey will only take a few minutes to complete. Providing us with your contact information will allow us to send you information and resources for the road trip. We'll also touch base with you at the end of the year to get your feedback on how everything went. We will keep your contact information confidential.

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1.
Please provide your name and contact information below:

Name:

Organization:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

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2.
What is your relationship with YALSA?

I'm a regular member

I'm a student member

I'm a retired member

My library is an organizational member

I'm not a member

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3.
What is the name of the school where you will be conducting a road trip activity?

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4.
What type of activity do you plan on doing? Please check all that apply.